Millions of Poor Left Uninsured Because of Medicaid Expansion Opt-Out

The New York Times published an infuriating report this morning that highlights the ways in which millions of poor Americans will be left without health coverage because 26 Republican-controlled states refused to expand Medicaid coverage. Two-thirds of poor black Americans and single mothers will be without coverage as will more than half of low-wage workers who currently lack insurance.

The refusal to expand Medicaid coverage creates a gap between people who, while still poor, have high-enough incomes to qualify for federal subsidies for the Affordable Care Act and those poor enough to qualify for Medicaid as it exists now. Basically, those left uncovered are people who earn too much for Medicaid in its current form, but not enough to qualify for subsidies for the ACA.

The problem is most acute in the South, where every state except for Arkansas refused to pass the Medicare expansions, which the federal government will pay for entirely until 2016 and at least 90 percent after that. Not surprisingly, the coverage gap will disproportionately affect poor blacks, with 6 out of 10 black people living in states not expanding Medicaid.

From the New York Times:

The 26 states that have rejected the Medicaid expansion are home to about half of the country’s population, but about 68 percent of poor, uninsured blacks and single mothers. About 60 percent of the country’s uninsured working poor are in those states. Among those excluded are about 435,000 cashiers, 341,000 cooks and 253,000 nurses’ aides.

“The irony is that these states that are rejecting Medicaid expansion — many of them Southern — are the very places where the concentration of poverty and lack of health insurance are the most acute,” said Dr. H. Jack Geiger, a founder of the community health center model. “It is their populations that have the highest burden of illness and costs to the entire health care system.”

The Times also notes that in Mississippi “56 percent of all poor and uninsured adults are black, though they account for just 38 percent of the population.” Of course, Republican State Senators in Mississippi who fought against the expansion argue race has nothing to do with it.

“Any additional cost in Medicaid is going to be too much,” said State Senator Chris McDaniel of Mississippi told the Times, and State Senator Giles said it was “preposterous” to consider race as a factor.

The expansion effectively doubles the income ceiling for Medicaid coverage for adults with children, from an average of $5,600 for states who rejected tthe expansion to $12,200 for those who adopted the expansion. But if you're childless, it doesn't matter how little you make; in states not expanding Medicaid, there's little-to-no coverage for adults without dependents.

The Times spoke to Willie Charles Carter, an unemployed former janitor living in Greenville, Mississippi who makes less than $3,000 a year but, because he has no children, does not qualify for insurance.

“You got to be almost dead before you can get Medicaid in Mississippi,” he said, adding that health center where he receives free treatment for a leg injury is closing next month due to a lack of funding. “I'm scared all the time. I just walk around here with faith in God to take care of me.”

[Image via AP]